1982739009 NPI number — SUPERINTENDENT OF CUSHMAN SCHOOL DIST 81

Table of content: (NPI 1982739009)

General

This information contains only most important part of the NPI data, for complete information, including NPI referencing materials please refer to 1982739009 NPI number — SUPERINTENDENT OF CUSHMAN SCHOOL DIST 81

Organization/Personal Information

Employer Identification Number (EIN):
Provider Organization Name:
SUPERINTENDENT OF CUSHMAN SCHOOL DIST 81
Provider Last Name:
Provider First Name:
Provider Middle Name:
Provider Name Prefix Text:
Provider Name Suffix Text:
Provider Credential Text:
Provider Gender Code:

Provider's Other Name Information

Provider Other Organization Name:
CUSHMAN SCHOOL DISTRICT
Provider Other Organization Name Type Code:
3
Provider Other Last Name:
Provider Other First Name:
Provider Other Middle Name:
Provider Other Name Prefix Text:
Provider Other Name Suffix Text:
Provider Other Credential Text:
Provider Other Last Name Type Code:

NPI Number Information

NPI Number:
1982739009
Entity Type Code:
Organization
Replacement NPI:
Last Update Date:
07/07/2008
NPI Deactivation Reason Code:
NPI Deactivation Date:
NPI Reactivation Date:

Provider's Business Mailing Address

Provider First Line Business Mailing Address:
45 PARK ST
Provider Second Line Business Mailing Address:
Provider Business Mailing Address City Name:
CUSHMAN
Provider Business Mailing Address State Name:
AR
Provider Business Mailing Address Postal Code:
72526
Provider Business Mailing Address Country Code:
US
Provider Business Mailing Address Telephone Number:
870-793-6321
Provider Business Mailing Address Fax Number:
870-793-7266

Provider's Practice Location Mailing Address

Provider First Line Business Practice Location Address:
45 PARK ST
Provider Second Line Business Practice Location Address:
Provider Business Practice Location Address City Name:
CUSHMAN
Provider Business Practice Location Address State Name:
AR
Provider Business Practice Location Address Postal Code:
72526
Provider Business Practice Location Address Country Code:
US
Provider Business Practice Location Address Telephone Number:
870-793-6321
Provider Business Practice Location Address Fax Number:
870-793-7266
Provider Enumeration Date:
02/22/2007

Additional Information

Authorized Official

Authorized Official Last Name:
LUSTER
Authorized Official First Name:
TAMMY
Authorized Official Middle Name:
LYNN
Authorized Official Title or Position:
DISTRICT TREASURER
Authorized Official Telephone Number:
870-793-6321

Provider Taxonomy Codes

  • Taxonomy code: 251300000X ; information, associated with the NPI states the following Primary Taxonomy Switch: "Y" .

Other Provider's Identifiers (legacy, non-NPI)

  • Identifier: 132478743 , issued by the state of ( AR ) . This identifiers is of the category "MEDICAID".




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